We are pleased to present this cutting edge clinical update report on cardiogenic shock (CS). Acute coronary syndromes and its complications are key components of emergency medicine practice. Specifically, CS is prevalent and occurs in roughly 10% of all cases of acute myocardial infarction (AMI). Despite numerous therapeutic advances in the treatment of cardiovascular disease, CS is still the leading cause of mortality among patients with AMI. This newsletter by Drs. Jeger, Anand and Hochman summarizes the classic CS paradigm and observations from the SHOCK trial challenging that paradigm.